|
LENS IO ALCON JF3LRU 18.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270603506
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 18.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270603506
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 19.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270606112
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 19.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270606112
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 19.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270606355
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 19.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270606355
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 20.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270605204
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 20.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270605204
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 20.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602244
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 20.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602244
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 21.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270605500
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 21.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270605500
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 21.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602245
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 21.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602245
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 22.0
|
Facility
|
OP
|
$2,264.00
|
|
| Hospital Charge Code |
270607507
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$339.60 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$679.20
|
| Rate for Payer: Aetna Medicare Advantage |
$679.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$577.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$577.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$577.32
|
| Rate for Payer: Cigna Commercial |
$1,132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$547.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.60
|
|
|
LENS IO ALCON JF3LRU 22.0
|
Facility
|
IP
|
$2,264.00
|
|
| Hospital Charge Code |
270607507
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$339.60 |
| Max. Negotiated Rate |
$547.89 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$547.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.60
|
|
|
LENS IO ALCON JF3LRU 22.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602246
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 22.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602246
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 23.0
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270602248
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS IO ALCON JF3LRU 23.0
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270602248
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS IO ALCON JF3LRU 23.5
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270623155
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS IO ALCON JF3LRU 23.5
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270623155
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS IO ALCON JF3LRU 24.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602249
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$548.67 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 24.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602249
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON JF3LRU 24.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602250
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$680.17
|
| Rate for Payer: Aetna Medicare Advantage |
$680.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.15
|
| Rate for Payer: Cigna Commercial |
$1,133.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$548.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|